Set Goals for 2009

The Department of Nursing in November celebrated the accomplishments and contributions of four Nursing committees following the first year of the new committee structure. Members of the four committees: Informatics and Clinical Innovations, Patient and Family Education, Quality, Safety and Care Improvements, and Standards, Policies and Procedures, the Nursing Coordinating Committee and the BWH nursing community marked the one-year anniversary with a celebration in Cabot Atrium.

“This celebration marks an important milestone for the Department of Nursing at Brigham and Women’s Hospital,” Mairead Hickey, PhD, RN, chief nursing officer and senior vice president for Patient Care Services, said.

The committee structure was reinvigorated last fall to bring together professional nurses from different practice areas and roles to shape, influence and recommend and/or approve decisions to improve the clinical practice environment in which nurses provide excellent care to patients and families. Each of the committees—which have a combined membership of more than 100 nurses—has made significant contributions to Nursing at BWH.

“We are improving the care for our patients and families through partnerships, collaboration and continuous learning,” Hickey said.

The purpose of the Informatics and Clinical Innovations Committee is to advocate for nursing practice to drive the development and implementation of technology to support and enhance the clinical nurse’s role in caring for patients while promoting patient and staff safety. The committee came together charged to serve as a forum for the review of new technologies affecting clinical nurses and to inform the configuration, implementation and ongoing support of new technologies and clinical systems. In addition, the committee identifies the need for new policies and procedures and training in advance of implementing new technologies.

The group came together with a clear set of goals for 2008, such as establishing the committee as a forum for review and approval prior to the selection of new technologies, identifying criteria related to the selection of new technologies and clinical information systems with an emphasis on critical human factors and workflow of the clinical nurse, and using the committee as a forum for feedback and continuous improvement for technologies in use at BWH.

During the last year, the Informatics and Clinical Innovations committee achieved many accomplishments, including:

Participating in the development and testing of the new eMAR scheduling tool

Partnering with BWH IS to improve wireless clinical laptop connectivity and validate the current version of the Alaris Drug Library

Offering nursing feedback for the implementation of the tamper-proof prescription printers

The group set ambitious but attainable goals for its second year. It will continue its role as a forum for feedback and review for selection, development and implementation of clinical system technologies with an emphasis on critical human factors and workflow of the clinical nurse. In addition, the committee will provide review and feedback for all Nursing BW/F Healthcare Information Technology Innovative Program (HIP) proposals, provide membership development within the field of nursing informatics and continue to strategize and implement new methodologies to communicate the work of the committee.

Patient and Famly
Education Committee

One of the first orders of business for the Patient and Family Education Committee was to establish a vision statement to guide its work: “Patients and families at Brigham and Women’s Hospital receive individualized, accurate and timely education throughout the continuum of care.”

The committee’s multi-faceted charge includes providing feedback on Department of Nursing patient education policies, procedures and standards based on best practices and Joint Commission standards. The committee also provides input into the goals of the Patient and Family Education Program and makes recommendations for necessary educational resources for patient and family education. It provides feedback on new technologies and media that can support the delivery of patient education determining which are cost efficient, accurate and user friendly, while creating a network of patient education champions who can serve as a resource at the unit level. The group evaluated four Web-based vendor sites and concluded that EBSCO and CareNotes provide the most accurate and user-friendly information.

For 2009, the committee will support the development and maintenance of the Patient and Family Education Web site. In addition, the committee plans to develop an effective communication structure for sharing Patient and Family Education resources with nursing staff. In a staff survey to determine preferences for receiving information about the Patient and Family Education Committee, nearly 90 percent of survey respondents said they preferred e-mail or face-to-face communication.

The purpose of the Quality, Safety and Care Improvement Committee is to foster a culture that promotes commitment to continuous improvement of patient centered care, quality and safety. This committee’s charges include identifying department systems and processes in need of improvement to advance patient-family centered care, outcomes and nursing practice, ensuring reliable and valid data are available to empower staff to participate in clinical decision-making and the development of clinical innovations and reviews department performance on nurse sensitive outcome measures and identifies opportunities for improvement. In addition, the committee recommends interventions to incorporate National Patient Safety Goals into clinical practice.

The committee also reviews data from hospital committees such as Ergonomics, Needle Safety Advisory, Drug Safety and Safety and Environment of Care and patient satisfaction surveys for significant patterns and trends pertinent to nursing practice and recommends interventions. This committee also identifies needs for new or revised policies, procedures or guidelines based on data from regulatory agencies, research and departmental or hospital-wide quality and safety initiatives. Lastly, the committee is charged with creating a network of quality improvement champions who can be a resource at the unit level.

In the past year, the Quality, Safety and Care Improvement Committee collaborated with Biomedical Engineering to revise the repair tag to enhance use and to reinforce the process for effectively identifying, labeling and requesting repair of broken equipment for faster turnaround time for use. The committee recommended practice change for hemoccult developer storage and queried nursing staff to identify the most effective means of communications for need-to-know information.

In addition, the committee reviewed patient falls data and provided input to the Nursing Falls Program, provided feedback on a restraint brochure and made recommendations to the hospital’s confidentiality committee on the best process for IV bag disposal with patient information. The committee also educated members on various quality and care improvement methodologies to demonstrate how these processes are used to affect practice.

In the next year, the committee anticipates achieving several goals, including:

Developing a hand hygiene program for the Department of Nursing

Creating a reporting feedback loop and developing a system of tracking issues presented at the meetings to monitor how recommendations were used and the impact on practice

Implementing a communication plan for how new information is shared to the department and establishing a timeline for input into the MHA Patient First data.

As a forum to coordinate, review and monitor practice standards, policies, procedures and guidelines based on current evidence-based information and practices, the Standards, Policies and Procedures Committee reviewed, updated, approved and disseminated approximately 160 policies, procedures and guidelines. In doing so, this committee ensured that the language and content of any standards, policies and procedures meet regulatory requirements and conforms with the language of other disciplines’ documentation.

To name just a few, the committee reviewed policies, procedures and standards related to:

intensive pain management therapy

use of central line insertion checklist

ambulatory clinics telephone triage

continuous renal replacement therapy with NXSTAGE System One

care of the patient experiencing pregnancy loss

The Standards, Policy and Procedure Committee continues to review policies, identifying those that need to be created as well as how to make all policies more easily accessible.

In addition, the committee collaborated with the Informatics and Clinical Innovations Committee to revise and improve the table of contents for the online Clinical Practice Manual, greatly improving access and search functions for clinical staff. And the committee implemented a monthly e-mail to the Nursing Master distribution list with standardized format to communicate new and revised policies, procedures and guidelines to all staff.

For the next year, the committee will continue to promote evidence-based practice by providing education to membership on use of library resources. In addition, the committee intends to refine and clarify the process of development of standards, policies, procedures and guidelines, assuring consistency on how information is organized and presented and to develop strategies to improve accessibility for staff.

Nursing Coordinating Committee

With the co-chairs and advisors from each of the above committees, this group brings together the work and interdependencies of each committee to ensure they are integrated and aligned with the Nursing Department goals and vision in key strategic areas. The coordination committee approves each committee’s work plan and raises issues to the Nurse Executive Board as appropriate.

This committee structure is designed to accomplish work in key strategic areas designated by the NEB and brings together the professional community of nurses from different practice areas and roles to influence, shape, guide, recommend and/or approve decisions.